Endoscopic Resection For Esophagogastric Junction Neoplasia,Screening Esophageal Cancer With Cytosponge,Study Of Head And Neck Cancer Associated With Esophageal Cancer

Part Ⅰ A retrospective study comparing endoscopic submucosal dissection (ESD) with endoscopic mucosal resection (EMR) in the treatment of early stage of esophagogastric junction neoplasiaIntroduction:Endoscopic resection has become a treatment option for esophagogastric junction (EGJ) neoplasia, but there is no single center comparing endoscopic submucosal dissection (ESD) with endoscopic mucosal resection (EMR). The aim of this retrospective study is to compare EMR with ESD on the feasibility, safety and effectiveness for EGJ neoplasia.Materials and Methods:130 patients with EGJ neoplasia underwent endoscopic resection, including 52 patients with EMR and 78 patients with ESD. EMR with cap and ESD procedures were performed with typical sequences. Resection time, adverse events, en bloc resection rate, RO resection rate and recurrence rate were evaluated between two groups.Results:There was no significant difference in demographic characteristics and histopathological features between two groups. Resection time was longer in ESD group than in EMR group (64.4 ± 33.9 minutes versus 22.1 ± 8.0 minutes; P<0.05). Adverse events were more common in ESD group than in EMR group (16.7% versus 3.8%; P< 0.05), as were bleeding (7.7% versus 3.8%), perforation (in 5.1% versus 0%) and stenosis (5.1% versus 0%). En bloc resection rate and R0 resection rate was much higher in ESD group than in EMR group(98.7% and 92.3% versus 23.1% and 23.1%; P< 0.05).Recurrence rate was lower with ESD group than with EMR group (0% versus 7.7%; P<0.05).Conclusions:Compared with EMR, ESD has much higher technical complexity in the treatment of EGJ neoplasia, but with higher en bloc resection and R0 resection rate, and lower recurrence rate. Therefore, results show inherent differences between EMR and ESD and prove that EGJ dysplasia had better be resected by ESD not EMR especially when they are>14mm in size. Furthermore, EMR may be a choice for the patients that could achieve en bloc resection.Part Ⅱ Screening esophageal squamous cell cancer and its precancerous lesions using the Cytosponge coupled with immunohistochemical staining for p53Introduction:China is a high incidence area of esophageal squamous cell cancer. In the high-risk areas of China, we conduct a program that endoscoping asymptomatic people with Lugol’s iodine staining. But even this ambitious endoscopic screening program cannot begin to evaluate the millions of adults who live in the high-risk areas of China and need to be screened for this disease. For this, a much simpler, less invasive and less expensive screening method must be devised. The aim of this prospective cohort study is to detect cytosponge coupled with immunohistochemical staining for p53 on the feasibility, safety and effectiveness.Materials and Methods:The median age of 87 patients is 58 years old (24～70), including 52 men (59.8%) and 35 women (40.2%). All patients were consented to the study, filled in a simple demographics CRF and were asked to swallow the Cytosponge right before their endoscopy was performed. As part as EDETEC, patients with HGIN or MGIN were treated endoscopically with MBM, EMR or ESD.Results:This study includes 28 cases of normal esophagus、11 cases of esophagitis、12 cases of low grade intraepithelial neoplasia(LGIN)、13 cases of moderate grade intraepithelial neoplasia (MGIN)、14 cases of high grade intraepithelial neoplasia (HGIN) and 9 cases of early esophageal squamous cell cancer (EESCC). There were no safety concerns. Out of the 87 patients recruited,62 (71%) prefered the CytospongeTM to endoscopy. The best biomarker was atypia and atypia alone yielded a sensitivity of 69.6% of HGIN and EESCC with a specificity of 93.8%, but the sensitivity of LGIN or MGIN is lower than 10%. Atypia with immunohistochemical staining for p53 yielded a sensitivity of 26.1% of HGIN and EESCC with a specificity of 98.4%.Conclusions:CytospongeTM is a much simpler, less invasive and easier to accept screening method. The use of atypia alone yielded the sensitivity for HGIN and EESCC of around 70% and this outcome is promising, but number of significant p53 CytospongeTM samples was significantly lower than expected.Part III The study of squamous cell cancer of head and neck cancer associated with squamous cell cancer of esophagusIntroduction:Patients with squamous cell cancer of head and neck cancer (HNSCC) often have synchronous or metachronous squamous cell cancer of esophagus (ESCC) Field cancerization is often used to explain this phenomenon. Multimodal therapy is essential for patients with multiple cancers. In patients with metachronous multiple cancers, the prior treatment of the first primary cancer often affects the treatment of the second cancer.Materials and Methods:8 patients (10 lesions) with ESCC underwent endoscopic submucosal dissection (ESD) for early hypopharyngeal cancer.3 patients with HNSCC underwent endoscopic mucosal resection via the transgastric approach for early esophageal cancer with cervical esophagus stricture. Fresh tumor tissue, peripheral blood lymphocytes (PBLs) and plasma obtained from 8 HNSCC associated with ESCC patients were performed next-generation gene sequencing to evaluate differences in mutations among tumor tissue, cfDNA and blood.Results:En bloc resection rate and R0 resection rate was 100% and 80% in patients with ESCC that underwent ESD for early hypopharyngeal cancer. No complication was occurred and no local recurrence was occurred during follow-up. We successfully performed 3 patients endoscopic mucosal resection via the transgastric approach for early esophageal cancer with cervical esophagus stricture in 3 patients. During the follow-up, no local recurrence was occurred. Tumor DNA and matched plasma cfDNA sample showed high concordance and cfDNA had a moderate mutation pattern, which was weaker than that of tumor tissue and stronger than that of blood. What’s more, there were five mutations (EGFR 8- p.E330*/13- p.P512L; ERBB212-p.L485/20-p.D821N; NRAS 5- p.K170N; PIK3CA 11- p.V580E,14- p.H701L; RB12- p.R46S/6- p.L199*) only identified in HNSCC but not in ESCC.Conclusions:ESD is a minimal invasive and effective method treatment for early hypopharyngeal cancer associated with HNSCC. We could perform endoscopic mucosal resection via the transgastric approach for early esophageal cancer with cervical esophagus stricture. Otherwise, we draw a conclusion that cfDNA shows differences both in mutations and concentration between HNSCC and ESCC, and may be a noninvasive biomarker.